Provider Demographics
NPI:1932279874
Name:DEWITT, STEPHEN F (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:DEWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:28800 RYAN RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4269
Mailing Address - Country:US
Mailing Address - Phone:586-558-3950
Mailing Address - Fax:586-558-7503
Practice Address - Street 1:28800 RYAN RD
Practice Address - Street 2:SUITE 230
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4269
Practice Address - Country:US
Practice Address - Phone:586-558-3950
Practice Address - Fax:586-558-7503
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301041306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101892762Medicaid
MI1110820001OtherTHE WELLNESS PLAN
MI503683OtherCARE CHOICES PREFERRED CH
MI4301041306OtherMI STATE LICENSE NUMBER
MI000000006021OtherCAPE HEALTH PLAN
MI1105037461OtherBCBSM PIN
MI217178600OtherUSDOL-OWCP
MIA77875OtherHEALTH ALLIANCE PLAN
MIDR500114OtherM-CARE
MIDR500114OtherM-CARE
MI0503746Medicare PIN
MI382408380OtherFEDERAL TAX ID NUMBER
MI110003587Medicare PIN